Credit Application LARKHILL LINGERIE INC. www.larkhill.com email: marketing@larkhill.com

Date this form filled out ___________________
 

Name of Business	.
Name of Owner	.
Name of Store Mgr.	.
Years in Business under this name	0 - 2 years  3 - 5 years  6 +  years
Additional Stores operating under this name	No  Yes             if Yes, the number of those stores  ____
Street Address	.
Street Address	.
Province	Postal Code

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tel:  (  ______ ) _______ - __________ ext _______	fax:  (  ______ ) _______ - __________ ext _______
email:	web site:

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Institution you bank with: Please check appropriate box Bank of Montreal Scotiabank CIBC National Trust TD Bank / Canada Trust Royal Bank TD Bank / Canada Trust Credit Union (specifiy) other .. write in name Bank Branch Address  _______________________________________                        (City) _________________

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References

Name of  business	tel: contact	City
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